Objective To investigate the different clinical characteristics and prognosis of patients with diabetic nephropathy(DN)accompanied byIgAdeposition diagnosed by renal biopsy.Methods The study was a retrospective cohort...Objective To investigate the different clinical characteristics and prognosis of patients with diabetic nephropathy(DN)accompanied byIgAdeposition diagnosed by renal biopsy.Methods The study was a retrospective cohort study.Clinical and pathological data of patients diagnosed with DN through renal biopsy in Beijing Anzhen Hospital affiliated to Capital Medical University from January 1,2010 to March 31,2023 were retrospectively collected.The clinical and pathological characteristics and prognosis of DN patients with IgA deposition and DN control group patients without IgA deposition were compared.Immunofluorescence staining was used to detect the intensity of galactose-deficient IgAl(Gd-IgA1)staining in renal tissue of DN patients with DN IgA deposition,and grouping was performed according to whether the staining intensity was≥2+.Enzyme linked immunosorbent assay was used to detect the serum level of Gd-IgA1 in patients.A 50%decrease in estimated glomerular filtration rate(eGFR)from baseline or progression to end-stage renal disease within 5 years was defined as a renal endpoint event,and Kaplan-Meier survival analysis and Log-rank test were used to compare the difference in cumulative incidence of renal endpoint events between two groups of patients.Results A total of 101 DN patients were enrolled in this study,including 68 males(67.3%)and 33 females(32.7%),with age of(52.2±10.3)years and a median follow-up time of 13.5(4.8,26.3)months.There were 44 patients with IgA deposition(43.6%)and 57 patients without IgA deposition(56.4%).Compared with DN control group,Kaplan-Meier analysis showed that DN patients with IgA deposition had a higher cumulative incidence of renal endpoint within 5 years(X^(2)=6.473,P=0.011).The proportion of positive glomerular Gd-IgA1(KM55)staining in the DN patients with IgAdeposition was54.5%(24/44),and immunofluorescence examination1showed consistent distribution of Gd-IgA1 and IgA in the glomerular mesangial and capillary regions.The serum level of Gd-IgA1 in the glomerular Gd-IgAl positive patients was significantly higher than that in those negative patients[(6296.4±1535.4)μg/L us.(4057.4±1082.0)μg/L,t=-3.037,P=0.010].In DN patients with IgA deposition,the age of the subgroup with endpoint events was younger[(42.8±6.9)years us.(53.3±9.4)years,t=-3.440,P=0.002],the duration of proteinuria was shorter[6.0(1.0,22.0)months us.12.0(10.0,36.0)months,Z=-2.150,P=0.032],and the proportion of patients with glomerular Gd-IgA1 staining intensity≥2+was higher[Fisher'exact test,30.8%(4/13)us.0(0/20),P=0.017].Kaplan-Meier survival analysis showed that patients with glomerular Gd-IgAl1 staining intensity≥2+had a significantly higher cumulative incidence of renal endpoint events(X=4.846,P=0.028).Conclusion DN patients with glomerular IgA deposition and Gd-IgAl positivity may be associated with worse prognosis.展开更多
文摘Objective To investigate the different clinical characteristics and prognosis of patients with diabetic nephropathy(DN)accompanied byIgAdeposition diagnosed by renal biopsy.Methods The study was a retrospective cohort study.Clinical and pathological data of patients diagnosed with DN through renal biopsy in Beijing Anzhen Hospital affiliated to Capital Medical University from January 1,2010 to March 31,2023 were retrospectively collected.The clinical and pathological characteristics and prognosis of DN patients with IgA deposition and DN control group patients without IgA deposition were compared.Immunofluorescence staining was used to detect the intensity of galactose-deficient IgAl(Gd-IgA1)staining in renal tissue of DN patients with DN IgA deposition,and grouping was performed according to whether the staining intensity was≥2+.Enzyme linked immunosorbent assay was used to detect the serum level of Gd-IgA1 in patients.A 50%decrease in estimated glomerular filtration rate(eGFR)from baseline or progression to end-stage renal disease within 5 years was defined as a renal endpoint event,and Kaplan-Meier survival analysis and Log-rank test were used to compare the difference in cumulative incidence of renal endpoint events between two groups of patients.Results A total of 101 DN patients were enrolled in this study,including 68 males(67.3%)and 33 females(32.7%),with age of(52.2±10.3)years and a median follow-up time of 13.5(4.8,26.3)months.There were 44 patients with IgA deposition(43.6%)and 57 patients without IgA deposition(56.4%).Compared with DN control group,Kaplan-Meier analysis showed that DN patients with IgA deposition had a higher cumulative incidence of renal endpoint within 5 years(X^(2)=6.473,P=0.011).The proportion of positive glomerular Gd-IgA1(KM55)staining in the DN patients with IgAdeposition was54.5%(24/44),and immunofluorescence examination1showed consistent distribution of Gd-IgA1 and IgA in the glomerular mesangial and capillary regions.The serum level of Gd-IgA1 in the glomerular Gd-IgAl positive patients was significantly higher than that in those negative patients[(6296.4±1535.4)μg/L us.(4057.4±1082.0)μg/L,t=-3.037,P=0.010].In DN patients with IgA deposition,the age of the subgroup with endpoint events was younger[(42.8±6.9)years us.(53.3±9.4)years,t=-3.440,P=0.002],the duration of proteinuria was shorter[6.0(1.0,22.0)months us.12.0(10.0,36.0)months,Z=-2.150,P=0.032],and the proportion of patients with glomerular Gd-IgA1 staining intensity≥2+was higher[Fisher'exact test,30.8%(4/13)us.0(0/20),P=0.017].Kaplan-Meier survival analysis showed that patients with glomerular Gd-IgAl1 staining intensity≥2+had a significantly higher cumulative incidence of renal endpoint events(X=4.846,P=0.028).Conclusion DN patients with glomerular IgA deposition and Gd-IgAl positivity may be associated with worse prognosis.
